Organization
PANGEA MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN RAY BLACK (M.D.)
(575) 578-4548
Entity
Organization
Contact information
Practice address
2604 GAYE DR, ROSWELL, NM 88201-3427
(575) 578-4548
Mailing address
2604 GAYE DR, ROSWELL, NM 88201-3427
(575) 578-4548
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
MD2011-0547
NM
261QP2300X
Primary Care Clinic/Center
MD2011-0547
NM
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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